Reporting Requirements under Federal Law and Regulations
Federal regulations require that as to any malpractice settlement, judgment, or arbitration award, along with the biographical information of the practitioner and any insurer involved, several pieces of information be filed with the NPDB. 45 C.F.R. § 60.5, 60.7 (2011). With respect to such settlements or judgments resulting in payment, any entity or insurer must provided the NPDB with the following information regarding the settlement: where the action or claim was filed with an adjudicative body including the case number, the dates on which the acts or omissions which gave rise to the action or claim occurred, the date of the settlement or judgment, the amount paid (including the date of payment and whether the payment was for a settlement or judgment), a description of any conditions or terms attached to the settlement, a description of the acts (or omissions, injuries, or illnesses) upon which the claim was based, and a classification of the acts based upon the reporting code. 45 C.F.R. § 60.7. The regulations specifically define a medical malpractice claim or action as “a written complaint or claim demanding payment based on a physician’s, dentist’s or other health care practitioner’s provision of, or failure to provide health care services, and includes the filing of a cause of action based on the law of tort brought in any State or Federal court or other adjudicative body.” 45 CFR 60.3. Sexual harassment, it is worth noting, is an intentional tort under substantive tort law, as are assault and battery. All such medical malpractice settlement payments must be reported to the board within 30 days of when the payment is made. 45 C.F.R. § 60.5(a).
Federal law also requires State Boards of Medical Examiners to report revocations or suspensions to the NPDB. 42 U.S.C. § 11132. State boards must report the revocation, suspension, or restriction of a physician’s license or any censures, reprimands, or probations placed on the physician relating to his professional competence or conduct. Id. the board would also have to require any surrender of such a license. Id. Likewise, federal law requires health care entities to report on adverse actions taken that affect a physician’s clinical privileges. 42 U.S.C. § 11133. Health care entities must report any adverse action taken affecting the clinical privileges of a physician lasting more than 30 days. Id. Likewise, health care entities must provide the NPDB with information regarding the surrender of the clinical privileges by a physician while such a physician is under investigation relating to possible incompetence or improper professional conduct or surrender occurring in return for the entity not conducting such an investigation or proceeding. Id. at (a)(1)(B). Substantive regulations likewise state that all of the following type of organization must report such adverse actions: hospitals, other health care entities, Boards of Medical Examiner State licensing authorities, professional societies of practitioners which take adverse licensure of professional review actions, State licensing or certification authorities, peer review organizations, and private accreditation entities that take negative actions or findings, as well as insurance companies making payments based upon medical malpractice actions or claims. 45 C.F.R. § 60.2. Any adverse action must be reported within 15 days when the entity took that action. 45 C.F.R. § 60.5(c)-(d). Any suspension of license or similar action must be reported within 30 days. Id. at (b). Ultimately, the information that must be reported to the NPDB includes information on any payment in settlement of a malpractice claim as defined above or any adverse action restricting licensure or privileges.